Healthcare Provider Details

I. General information

NPI: 1689771529
Provider Name (Legal Business Name): BATH RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S WALNUT ST
BATH PA
18014-1025
US

IV. Provider business mailing address

310 S WALNUT ST
BATH PA
18014-1025
US

V. Phone/Fax

Practice location:
  • Phone: 610-837-9992
  • Fax: 610-837-7411
Mailing address:
  • Phone: 610-837-9992
  • Fax: 610-837-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413805L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VENUGOPAL NARRAMNENI
Title or Position: PHARMACY MANAGER / DIRECTOR
Credential:
Phone: 610-837-9992